Bradley James, Lee Zelyn, Cheong Melina
Hemoglobinopathy Clinic, Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
Red Blood Cell Disorder Clinic, Division of Haematology, University Health Network, Norman Urquhart Wing, 7th Floor, Room 700 585 University Ave, Toronto, ON M5G 2N2, Canada.
Health Care Transit. 2024 Jan 12;2:100040. doi: 10.1016/j.hctj.2023.100040. eCollection 2024.
The transfer from paediatric to adult care presents a significant challenge for adolescents and young adults (AYA) with sickle cell disease (SCD). Disease self-management skills have been recognized as important mediators of poor health outcomes, but transition-related skills such as scheduling appointments and understanding the shift in health care responsibilities remain under taught in the healthcare system. The purpose of this quality improvement (QI) study was to (1) understand the areas of disease self-management that AYA patients felt underprepared for, and (2) design and evaluate an educational program addressing the top unmet skills.
The Plan-Do-Study-Act (PDSA) model was implemented in a tertiary outpatient clinic between September 2020 and July 2021. Patients were surveyed during regular clinic visits to identify their priorities on disease self-management skills. Based on the results, a virtual workshop was created and administered three separate times. Feedback was collected using an electronic survey.
'Navigating the adult health care system' was the top self-management skill that AYA patients (n = 39) identified needing more support with. The majority of participants (79%, n = 14) reported that the virtual workshop was excellent, with 'appointment management' being the most useful topic discussed. Participants also reported feeling more confident (71%) and aware (86%) of how to navigate adult care.
This QI study showed that delivering a virtual workshop on transition skills was well received by AYA participants with SCD. The PDSA framework was useful for identifying specific knowledge gaps in transition aged AYA to help improve patient education in a well-established transition program.
对于患有镰状细胞病(SCD)的青少年和青年(AYA)而言,从儿科护理过渡到成人护理是一项重大挑战。疾病自我管理技能已被视为健康状况不佳的重要调节因素,但诸如安排预约和理解医疗保健责任转变等与过渡相关的技能在医疗系统中仍未得到充分教授。这项质量改进(QI)研究的目的是:(1)了解AYA患者认为在哪些疾病自我管理领域准备不足;(2)设计并评估一个针对最未得到满足的技能的教育项目。
2020年9月至2021年7月期间,在一家三级门诊诊所实施了计划-执行-研究-改进(PDSA)模型。在常规门诊就诊期间对患者进行调查,以确定他们在疾病自我管理技能方面的优先事项。根据结果,创建并分三次举办了一个虚拟研讨会。通过电子调查收集反馈意见。
“适应成人医疗保健系统”是AYA患者(n = 39)确定需要更多支持的首要自我管理技能。大多数参与者(79%,n = 14)报告称虚拟研讨会非常出色,“预约管理”是讨论中最有用的主题。参与者还报告说,他们对如何适应成人护理更有信心(71%)且更了解情况(86%)。
这项QI研究表明,为患有SCD的AYA参与者举办的关于过渡技能的虚拟研讨会受到了好评。PDSA框架有助于识别AYA过渡年龄段的特定知识差距,从而在一个成熟的过渡项目中帮助改善患者教育。